Research on Smoking and Prostate Cancer

Posted on December 1, 2011 by jelandry
Apparently, there’s another reason to quit smoking: A study published in the Journal of the American Medical Association suggests that smoking at the time of prostate cancer diagnosis is associated with an increased risk of prostate cancer recurrence as well as an increased risk of dying of prostate cancer. This is the first large-scale study to demonstrate that smoking increases the risk of dying of prostate cancer.

Researchers followed 5,366 men diagnosed with prostate cancer over two decades. Of these, 1,630 died — 524 due to prostate cancer and 416 due to cardiovascular disease –and 878 had recurrences of their prostate cancer after treatment. When compared with men who had never smoked, those who were smoking at the time of diagnosis had an approximately 60 percent greater risk of both prostate cancer recurrence after treatment and death due to prostate cancer. Furthermore, the greater the number of years spent smoking, the greater the risk of death due to prostate cancer. 

On a positive note, the study demonstrated that participants who had quit smoking for 10 or more years experienced prostate-related death and recurrence rates similar to those of nonsmokers. 

African Americans have the highest incidence of prostate cancer, followed by white Americans. Although the cause of prostate cancer remains unknown, risk factors include age, family history, race and hormone levels — with advancing age being the most notable risk factor. 

The American Cancer Society recommends that men at average risk discuss prostate cancer screening with their doctor at age 50. For African Americans and men with a family history of prostate cancer, the society recommends having the discussion even earlier—starting at 40 to 45 years of age. 

Take away. As many of us already know, smoking is linked to a variety of deadly diseases, including cardiovascular disease and lung cancer. For multiple reasons, if you’re a smoker, it’s always a good idea for you to quit. This study suggests that if you have prostate cancer and you smoke, it makes sense to quit for this reason, too. And if you’re at increased risk for prostate cancer, it’s smart to quit now in case you’re later diagnosed with the disease. 

 

This article was published by the John Hopkins Health Alerts which you can receive by subscribing here.

Posted in Basic Science and Research | Tagged , , , , | Leave a comment

Who Has the Best Breakfast in Houston?

Posted on November 18, 2011 by jelandry

BY SARAH RUFCA published in Houston Culture Map

11.15.11 | 04:18 pm

Breakfast: It’s the meal with the most important clichés. Or something. But when it comes to restaurants, breakfast often gets the shaft, replaced with the weekend’s sluttier brunch.

Texas Monthly picked out the 40 best breakfast places in the December issue, and of course Houston has several spots represented.

The list is divided by city and doesn’t have any rankings, but a stunning full-page spread devoted to the eggs benedict at Ouisie’s Table is probably a sign of something good. Owner Elouise Adams Jones began offering breakfast again this year (it was at the original Ouisie’s but never before in the current iteration). Other newbies making it onto the list include Down House, praised for the local egg omelets, fried egg sandwich and pulled-pork hash, and a mention for Pondicheri‘s morning thali.

Of course, the list wouldn’t be complete without a couple of standards, like The Breakfast Klub and its famous waffles and wings, Avalon Diner‘s pigs in a blanket and migas at Merida in the East End.

There are a couple of surprises, too, including Gulfgate’s Dot Coffee Shop (I do love that place, but it’s mostly because I re-enact scenes from Reality Bites whenever I’m there), the Urban Harvest Farmers Market at Eastside (an unorthodox choice, but I can’t argue with delicious) and venison sausage at Goode Company Taqueria. Houston’s Katz Coffee also gets a mention as a local roast to look for around town.

What’s your favorite breakfast spot in town?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

MY FAVORITE: The Dot Coffee Shop is a Houston original, and a throwback to the great coffee shops, American style diners and truck stops. Dot opened in 1967 and was the first of Pappas restaurants. The doors are never locked and for 24 hours a day 7 days a week you can get breakfast, hamburgers and the best chicken fried steak. You can people-watch in relative safety even in the wee morning hours because there’s usually a cruiser or two in the parking lot as Houston’s finest eat there. They don’t list calorie counts – the numbers would be too shocking – and as you enter walk up to the cashier you’re faced with a display case full of pies. Ah, I can see the coconut cream pie now.
-  jelandry November 2011

MRS JAKUB’s FAVORITE: This week I learned that one of the Pals had what she considered the best Sunday brunches in the area, maybe the region. Capt. Joe and the Mrs. took a week end in Galveston to get away from all the tribulations around the Medical Center and for brunch found their way to Bernado’s in Galveston. Located in the Hotel Galvez and Spa (Wyndham) it is right on Galveston Beach. It’s a long standing tradition and I believe since Mrs. Jakub is a full time travel agent, she knows what she’s talking about.

Posted in Annoucements, Where to Eat in Houston | Leave a comment

AUA Response to 2011 U.S. Preventive Services Task Force Draft Recommendations on Prostate Cancer Testing

Posted on November 10, 2011 by jelandry

SENT VIA E-MAIL TO: Robert.Cosby@ahrq.hhs.gov

November 8, 2011

Virginia Moyer, MD, MPH
Chair
U.S. Preventive Services Task Force
c/o Dr. Robert Cosby
540 Gaither Road
Rockville, MD 20850

Dear Dr. Moyer,

On behalf of the more than 13,000 urologists and urologic health professionals in the United States whom we represent, the American Urological Association would like to submit our comments on the U.S. Preventive Services Task Force’s Draft Recommendations on Screening for Prostate Cancer.

It is the opinion of the American Urological Association that these recommendations, in their current form, do a great disservice to the many men in this country who could benefit from talking with their doctors about prostate cancer. Prostate cancer is a potentially devastating disease that is best managed when caught early. Though we are well aware of the limitations of the serum prostate-specific antigen (PSA) test, we are unable to appropriately manage those tumors that we do not know exist. It is the PSA test that has allowed us to move beyond a time when men presented with high-grade, metastatic disease for which there were little or no treatment options beyond palliative care. In its earliest stages, most prostate cancers cause no symptoms; to say that only men with symptoms of prostate cancer should be tested will potentially result in a return to such a time.

We recognize the Task Force’s concerns about over-diagnosis and treatment, and understand that overtreatment of over-diagnosed prostate cancers is common (90 percent of men with detected prostate cancer receive some form of treatment). We also recognize that, in some cases, treatment of prostate cancer can result in serious harm without any benefit for those who are over-diagnosed and over-treated. However, we stand firmly in our belief that the PSA test – when used and interpreted appropriately – provides valuable information in the diagnosis, pre-treatment staging or risk assessment and monitoring of prostate cancer, especially in younger men.

However, we also agree that the current “one size fits all” approach to screening (testing men annually, testing men in their 70s more often than men in their 50s) leads to over-diagnosis of cancers that would otherwise not have been detected during life. Screening less frequently or not at all for those men with low PSA levels and those who are older and in poor health, would reduce over-diagnosis. We need a new testing paradigm – and a more specific biomarker – to better target those men who can benefit from testing.

Simply put, just as it is inappropriate to issue a “one size fits all” pro-screening message, it is equally inappropriate, and potentially irresponsible, to issue a blanket statement against testing, as studies have demonstrated strong benefits to prostate cancer screening. We believe that there is strong evidence that, for some men – generally those younger and in good health – testing saves lives. Men who are in good health and have more than a 10-15 year life expectancy should have the choice to be tested and not discouraged from doing so.

The randomized trials quoted by the Task Force do, in fact, show a benefit to younger patients. The PLCO Trial, imperfect by the pre-screening contamination of the control arm, nonetheless showed that, in a group of young men with minimal or no comorbidities, there was significant reduction of prostate cancer death rates after a median follow-up of seven years (JCO 2011;29:355-361). Additionally, the Göteborg Trial also showed a substantial 44 percent relative risk reduction in prostate cancer mortality occurring in men 50-64 years of age after a median of 14 years. Importantly, the risk reduction occurred in a setting where many of the patients were not aggressively treated for prostate cancer, indicating that the harms of PSA-based screening can, in fact, be minimized by good clinical practice (Lancet Oncol 2010;11:725-732). Furthermore, we have seen a 40 percent reduction in prostate cancer-specific mortality in the United States over the most recent 20 years of PSA-based screening. This has occurred without substantial change in how men with prostate cancer were treated (primarily with surgery and radiation therapy). Models have suggested that more than 50 percent of this reduction is due to early detection (Cancer Cases Control 2008;19:175-181).

Rather than instruct primary care physicians to discourage men from having a PSA test, the Task Force should instead focus on how best to educate primary care physicians regarding targeted screening and how to counsel patients about their prostate cancer risk. Likewise, we also need to demonstrate to patients how active surveillance may be more appropriate than immediate treatment, and how this approach helps reduce the harms of screening. In fact, the AUA has convened a team of clinical experts to develop a guideline on the Detection of Prostate Cancer, which, when released, will provide critical guidance to the medical community on these issues.

Issuing a “Grade D” recommendation for the PSA test sets a course that may, in fact, do more harm than good. The screening trials previously mentioned are very early in their analysis, but appear to show quite clearly that young men benefit most from PSA screening. This test has allowed early diagnosis of a cancer that, when confined to the prostate, is still curable, but when outside the confines of the prostate, is not. We believe that disparaging the PSA test does a great disservice to our patient population and that it is not the PSA test itself – but rather what is done with the information – that has created much of the controversy. The future should involve screening a more focused, healthy population, with a contemporary discussion of all therapeutic options, including active surveillance by knowledgeable providers, and integrating better molecular markers and imaging into the decision pathways.

The AUA would welcome the opportunity to work with the Task Force on revising its recommendations to ensure that we move forward, not backward, in our fight against prostate cancer.

Respectfully submitted,

Sushil S. Lacy, MD - AUA President

Sushil S. Lacy, MD, FACS
President

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Last Chance to Keep PSA Test for Your Sons and Grandsons

Posted on November 6, 2011 by jelandry

Position of the ProtonPals – withdraw draft recommendation and continue to use PSA screening as an early detection tool.  Final Letter to the US Preventive Service Task Force Recommendation Statement – A letter written by Dave Stevens on behalf of himself and ProtonPals, Ltd. on representing views of the organization as approved by the board.  Letter November 7, 2011. 

Letter written in response to USPSTF PSA Recommendation Statement

Posted in Diagnosis, PSA SCREENING | Tagged , , , , , , , , , | Leave a comment

Local Attorney and Lupron Legionnaire Asks, "What about the Facts?"

Posted on November 2, 2011 by jelandry

The US Preventive Services Task Force (USPSTF) Draft Recommendation Statement of October 8, 2011 recommends against PSA-based screening for prostate cancer in all age groups, even though measurement of serum prostate specific antigen (PSA), a biomarker for prostate cancer, has proved itself useful for the detection of early prostate cancer for the nearly 25 years the PSA test has been widely used in this country. Some of us wonder how this Task Force could recommend that men ignore PSA testing.

The surprising answer is revealed from a review of the Task Force draft and the medical literature it cites. But first, you need to know that just in the past two years, three randomized prospective studies have been reported on the use of the PSA test: The American study of about 75,000 men, a 7 country European study of about 180,000 men, and a study in Goeteborg, Sweden of about 20,000 men. The Swedish study found that after 14 years from the date the men were screened, prostate cancer deaths were cut almost in half. The European study found that after only 9 years from the screening date, prostate cancer deaths were cut by 20%. By contrast, the American study found that after 7 – 10 years of follow up, the rate of death from prostate cancer did not differ significantly between the PSA group and the non-PSA group.

Which study do you think the Task Force relied on? You’re right if you guessed the American study. What is so amazing is that the American study is so flawed. Let’s take a minute and see how:

  • In the American study, substantial numbers of both the control arm (i.e., the non-PSA screened) group and the intervention arm (the PSA screened group) underwent PSA screening. If you’re comparing PSA screening with no PSA screening, all of the men in one of the 2 groups are screened and none of the men in the other group are screened, right? Well, that’s not what happened in the American study. Instead, the American study compared one group of men where 52% had PSA screening while 85% of the other group had PSA screening. When you have 52% of the non-PSA group taking the test, you have what is called “contamination” of the control group. By contrast, the Swedish study had only 3% contamination and the European study had only 20% contamination. No wonder the results of the PSA test in the American study were so poor, compared to the Swedish study and the European study.
  • Follow up biopsy rates on patients with positive PSA readings were low in the American study (40%), compared to the 90% biopsy rate in the European study and 93% in the Swedish study. Unless you follow up a positive PSA test with a biopsy, you can’t begin to tell whether the PSA test actually reveals prostate cancer or not. Yet the American study follow ups were half-hearted at best, compared to the European and Swedish studies.
  • The follow up times in the American study were way too short, compared especially to the Swedish study. The follow up time in the American study in which the death rates were measured from the date of the PSA test was only 7-10 years in the American study, compared to 14 years in the Swedish study (and only 9 years in the European study). Medical studies demonstrate that you can use the PSA test and a biopsy to find out whether you have cancer or not many years before the cancer actually shows up from a DRE or other symptoms. In this way, the PSA test enables early detection of prostate cancer by many years, compared to not taking it. In one well-known study, the PSA test advanced prostate cancer diagnoses by as much as 12 to 14 years among men aged 55, and by 5 to 6 years for men aged 75. Seven to ten years in the American study is not nearly long enough to compare death rates with PSA and death rates without the test. Because the Swedish study measured the death rates 14 years after the PSA tests were taken, by then there were many more men without the test showing up with prostate cancer. The Swedish study was a fair test of PSA screening, while the American study was not.

Despite these and other flaws in the American study, that study is the foundation of the Task Force recommendation. The Task Force never seriously addressed the findings of either the Swedish or the European studies.

In conclusion, it’s easy to understand why Patrick Walsh, M.D., University Distinguished Service Professor of Urology, Johns Hopkins Medical Institutions has this to say about the Task Force recommendation: “If you are the kind of person who doesn’t wear a seat belt nor goes regularly to the dentist or your family doctor for a check-up and are not worried about dying from prostate cancer, do not undergo PSA testing. On the other hand if you are a healthy man age 55-69 who does not want to die from prostate cancer, the [European trials provide] conclusive evidence that PSA testing can save your life.”

- Dave Stevens, Houston, October 2011

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Save the PSA Test

Posted on November 2, 2011 by jelandry

Recommendations by a Survivors’ Group (adapted from a John Hopkins paper)

By now, you’ve probably heard that prostate-specific antigen (PSA) screening is no longer recommended for healthy men under age 75. This controversial draft recommendation was issued by the United States Preventive Services Task Force (USPSTF). Given previous recommendations from the medical community encouraging PSA screening, many men are confused. Following are answers to some questions you may have about this recommendation — and our advice on whether you should follow it.

What is the USPSTF? The USPSTF is an independent group of 16 medical experts whose recommendations serve as guidelines for doctors throughout the country. In addition, the group’s recommendations ultimately impact what tests Medicare and private insurers will pay for.

What fields of expertise are represented by the members of the task force? The panel members biographies are listed  on the USPSTF website and all have outstanding credentials in their field. It was pointed out by a national spokesman who supports PSA screening that regrettably none are trained in urology, oncology or have prostate cancer patients under their care.  USPSTF Members

Where can I find a copy of the draft recommendations?  The draft recommendations are published on the USPSTF website for public comment.  Get a copy of the USPSTF recommendations

Where can I take action to save the PSA test? You can do your part by commenting publicly on this draft. You have until November 8th to go to this site and make your comments.  Provide public comment on the USPSTF recommendations

Where can I read what others, including experts, have written in their comments?  William J. Catalona, M.D., world renowned urologist has written at length on the initial reports and has commented on the recommendations. You can use and cite his work as a reference as you write your notes. Dave Stevens, a director with ProtonPals, Ltd. has submitted a 3 page calling into question the conclusions and several aspects of the study. His paper is based on his in-depth research which he submitted to Robert Cosby, M.D. USPSTFs as his and ProtonPals official comments. It can serve as a guide in formulating your comments. Get a PDF copy here. 

Why did they make this recommendation? According to the USPSTF, the potential harms caused by prostate-specific antigen (PSA) screening of healthy men as a means of identifying prostate cancer far outweigh its potential to save lives. The group discourages the use of any screening test for which the benefits do not outweigh the harms to the target population.

What are the potential harms of PSA screening? An elevated PSA reading can lead to an unnecessary prostate biopsy. Although biopsies often reveal signs of cancer, depending on a man’s age, 30 to 50 percent will not be harmful — even if left untreated.

After a positive biopsy comes the decision about what to do. Most men choose radical prostatectomy, external-beam radiation therapy or brachytherapy. But each of these treatments has the potential to cause serious problems like erectile dysfunction, urinary incontinence or bowel damage. And men who choose active surveillance must live with the uncertainty of knowing that they have an untreated cancer that could start to progress at any time.

Why does the Task Force believe PSA screening does not save lives?  The USPSTF evaluated data from five large randomized clinical trials of PSA testing, including the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Trial, which reported no mortality benefit among 77,000 men who underwent PSA testing and were followed for 10 years.

Do these recommendations apply to all men? These recommendations apply to all men regardless of age, race or family history as long as they do not have symptoms of prostate cancer.

Do these recommendations find wide support with experts in the field?  The answer is a resounding NO based on an exclusive new survey by U.S. News & World Report of top doctors. There is wide support for PSA screening and they point out that it’s the first step in a diagnosis. Starting in 1994 there has been stage migration, i.e. fewer patients show up at their doctors office with late stage metastatic prostate cancer. Virtually all responding urologists and more than 60 percent of internal- medicine specialists reject the proposal to end routine PSA testing.

What does our doctor, who’s a genitourinary oncologist in radiation oncology, recommend? Dr. Andrew K. Lee, medical director of the MD Anderson Proton Center and associate professor of radiation oncology, believes the task force’s conclusion is premature. He encourages men to be screened, especially if they’re at a high risk.

“It’s a personal decision, of course,” he says. “But it’s a good idea to talk to your doctor and educate yourself about the pros and cons of the test – and prostate cancer in general.”

“Remember, the PSA is just a blood test,” Lee says. It does not make the diagnosis by itself, but it is a valuable tool to early detection.”

What can I do to keep this draft from becoming the official guidelines followed by my family doctor?  You can write to your elected officials by using this site provided by ZEROCancer. With the web based tool all you need is your zip code and it will have a preset draft letters that you can customize or rewrite. The tool will email your letters to the senators and representative of your area. In my case, since I live in Texas, it mailed my letters to my two senators Honorable Kay Bailey Hutchinson and John Cornyn and the representative from my district, Honorable Pete Olson.  Write a letter to your elected officials.

How can I write to the Editors of my local newspapers? As explained above all you need is your zip code and the tool on the ZEROCancer web site to mail a letter to your local newspapers. It will provide you with preset text that you can customize or rewrite. Pressing send will mail your letter to them. Submit a letter to your local newspaper.

Our Advice (On behalf of the ProtonPals). Many leading cancer patient groups and doctors agree that routine PSA screening is essential for early detection and dropping its use completely can cause more harm than good. As a survivors group founded in 2007 and representing almost a thousand prostate cancer survivors, not one patient has complained of being over treated.

PSA screening is the best test available for the detection of cancer cells in the prostate. Rather than discontinuing use of the only test available to detect the disease early and treat it successfully, efforts should focus on reducing harm of treating patients with low risk of metastatic disease.

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So, you’re going to write your Congressman? Good idea. Make it a good letter.

Posted on November 1, 2011 by jelandry

People who think members of Congress pay little or no attention to constituent mail, are plain wrong. Concise, well thought out personal letters are one of the most effective ways Americans have of influencing law-makers. But, members of Congress get hundreds of letters and emails every day. Whether you choose to use the Postal Service or email, here are some tips that will help your letter have impact.
Think Locally
It’s usually best to send letters to the representative from your local Congressional District or the senators from your state. Your vote helps elect them — or not — and that fact alone carries a lot of weight. It also helps personalize your letter. Sending the same “cookie-cutter” message to every member of Congress may grab attention but rarely much consideration.
Keep it Simple
Your letter should address a single topic or issue. Typed, one-page letters are best. Many PACs (Political Action Committees) recommend a three-paragraph letter structured like this:

  1. Say why you are writing and who you are. List your “credentials.” (If you want a response, you must include your name and address, even when using email.)
  2. Provide more detail. Be factual not emotional. Provide specific rather than general information about how the topic affects you and others. If a certain bill is involved, cite the correct title or numberwhenever possible.
  3. Close by requesting the action you want taken: a vote for or against a bill, or change in general policy.

The best letters are courteous, to the point, and include specific supporting examples.
Addressing Members of Congress
To Your Senator:

The Honorable (full name)
(Room #) (Name) Senate Office Building
United States Senate
Washington, DC 20510

Dear Senator:

To Your Representative:

http://www.capwiz.com/zerocancer/issues/alert/?alertid=54315501&type=CO

Message sent to the following recipients:
Senator Cornyn
Senator Hutchison
Message text follows:
Joseph Landry
15806 Manor Square Drive
Houston, TX 77062-4743
October 30, 2011

[recipient address was inserted here]

Dear [recipient name was inserted here],
The U.S. Preventive Services Task Force (USPSTF) appointed by the US
Government is putting the lives of thousands at risk by disparaging the
validity of the PSA test and eventually eliminating the option of testing
for all American men. Prostate cancer is one of the top ten cancers in men
only surpassed by lung cancer. The American Cancer Society says that
230,000 new cases of prostate cancer will be diagnosed this year and
33,000 men will die of it. One form of this cancer is not indolent and
slow growing and if you don’t get rid of it early in it’s cycle it
will kill you.
Since the simple blood test for PSA was adopted in the early 1990s for
prostate cancer screening, death rates from prostate cancer have dropped
over 40%, and 90 percent of all prostate cancers are now discovered before
they spread outside the gland.
Without PSA testing, there is no mechanism for early detection of prostate
cancer, leaving thousands of men vulnerable and unprepared to fight the
disease.
Guidelines on how best to test and cure prostate cancer should be based on
best practices of our centers of excellence, like the American Urological
Association.
As one of your 76 year old constituents in Clear Lake, Texas who is a
survivor and the founder of a national prostate cancer survivors group, I
urge you to take a stand to keep the recommendations from being adopted by
the U.S. Preventive Services Task Force. Please contact the Secretary of
Health who appointed the panel and ask that they reconsider this cavalier
decision that leaves men without the ability to protect their health.
I was present when a world class urinary disease oncologist in a Twitter
conference asked, Virginia A. Moyer, M.D. Chair of the task force, “If the data needs more study why are the recommendations so specific.”  Test for men over 75 is not recommended, italics mine.
Sincerely,
Joseph Landry
832 335 0353

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How to Comment on the USPSTF Draft Recommendations

Posted on October 31, 2011 by jelandry

Here’s how you may want to approach the task of writing to the USPSTF. 

  1. PRINT A COPY OF Dr. Catalona’s COMMENTS TO THE USPSTF RECOMMENDATIONS Click here  for a PDF copy.
  2. READ HIS RESPONSES TO THE SIX SECTIONS, THEN DRAFT YOUR OWN COMMENTS EITHER BY CITING HIS REMARKS (they know who he is) OR HIS REFERENCES TO SUPPORT YOUR COMMENTS.
  3. ENTER YOUR COMMENTS IN THE PUBLIC USPSTF WEBSITE.  Provide Public Comment on the Recommendations
  4. COMPLETE THE COMMENTS BY SHARING YOUR STORY AND IDENTIFY THE GROUP YOU REPRESENT IF YOU LIKE.
  5. SHARE WHAT YOU WROTE WITH US.

Copyrighted by Urological Foundation  Permission has been given by Dr. Catalona  to reproduce and use by ProtonPals in responding to the USPSTF recommendations.

How could the USPSTF make this draft Recommendation Statement clearer?

  1. The draft recommendation statement includes misinformation that needs to be corrected, not just for clarity but for accuracy.
  2. Contrary to What Dr. Virginia A. Moyer, the pediatrician who chaired the USPSTF panel, has said in the popular media, the USPSTF should acknowledge the evidence that screening in certain patient groups, such as healthy patients and younger patients, reduced prostate cancer (PC) death rates. 
  3. The primary endpoint of the randomized clinical trials (RCTs) was PC-specific mortality, not all-cause mortality.  The RCTs were neither designed nor powered to evaluate all-cause mortality. However, it is possible with longer follow-up, the all cause survival will be significantly longer in these patient populations screened with PSA.  The USPSTF therefore needs to acknowledge that PSA screening has been shown to reduce deaths from prostate cancer, and that follow-up was too short in the existing studies to adequately address all-cause mortality. 
  4. The USPSTF recommendation does not take into account the “number needed to treat” (NNT) to prevent 1 case of metastatic disease.  This NNT is much lower than that to prevent to prevent 1 PC death. Preventing advanced disease causes a reduced financial burden on the healthcare system and an incalculable reduction in human suffering.
  5. Data from the low-quality randomized clinical trials (RCTs) or RCTs designed with a different goal should not have been combined in meta analyses with data from 2 higher quality RCTs that showed substantial PC mortally benefits. In this regard, Roobol et al called the meta analysis by Djulbegovic et al “seriously flawed.” In contrast, the ERSPC and Goteborg trials showed that
    PSA screening resulted in 20% and 44% reductions in PC mortality, respectively. This dilution of the mortality benefits by combining the data from these heterogeneous trials was foreseeable.
  6. USPSTF should also acknowledge the 44% mortality benefit with a NNT to prevent 1 PC death of 5 in the healthier PLCO trial subgroup reported by Crawford et al.
  7. USPSTF should explain that PSA screening as performed in these RCTs is not representative of the way PSA screening is currently practiced today, and thus the results are of limited current relevance.
  8. USPSTF should acknowledge that high-risk populations, such as African Americans, have not been adequately studied for PC mortality benefits.
  9. USPSTF should acknowledge the > 40% PC mortality benefit in epidemiologic data from SEER (more than for any other cancer in men or women) and similar patterns in the global World Health Organization (WHO) data during the PSA era.

What information, if any, did you expect to find in this draft Recommendation Statement that was not included?


  1. Subgroup analysis of healthier PLCO men (44% mortality benefit with NNT= 5)
  2. Epidemiologic evidence that screening decreases PC mortality; SEER data shows 75% decrease in metastases at diagnosis during PSA era and 40% decrease in the age-adjusted PC mortality; WHO data show similar trends where PSA has been adopted but not where it has not.
  3. Citing NCI modeling team study estimating 45-70% of the PC mortality benefit is attributable directly to PSA screening
  4. Citing NCI modeling team’s lower estimates of over diagnosis using U.S. statistical models with SEER data compared to the widely-quoted Rotterdam models and data
  5. Citing published surgical series showing that under diagnosis is more common than over diagnosis in patients treated with radical prostatectomy. PC is still detected too late more often than too early.
  6. Pointing out that men with a 10-year life expectancy would have more options and a better chance of avoiding metastases and death from PC by having a discussion of the benefits and risks of PSA screening and then proceeding according to NCCN guidelines
  7. Pointing out that patients needing treatment can be informed about all of the options and seek expert doctors for treatment with fewest side effects

Based on the evidence presented in this draft Recommendation Statement, do you believe that the USPSTF came to the right conclusions? Please provide additional evidence or viewpoints that you think should have been considered.

I believe the USPSTF committee not only came to the wrong decision, but, if implemented, the resulting effects would be harmful, life-threatening and unconscionable.

  1. They did not review all relevant literature, nor did they interpret it properly.
  2. The AUA and the ACS have adopted positive recommendations for screening, and NCCN guidelines help implement screening.
  3. USPSTF’s recommendation polarizes the medical community and confuses patients and physicians.
  4. Over diagnosis and over treatment are exaggerated in the literature and popular media.
  5. I have prepared an article that provides evidence that should have been considered in the recommendations:  See www.drcatalona.com  page 1 article: Ramon Guiteras Lecture: Early Diagnosis of Prostate Cancer through PSA Testing Saves Lives Read more

What resources or tools could the USPSTF provide that would make this Recommendation Statement more useful to you in its final form?
I don’t believe this recommendation statement is helpful or accurate no matter what additional tools are provided.   Instead, more accurate information would need to be provided.

  1. Point out that high-risk men have not been adequately represented in studies, and avoiding PC death may be more important for them.
  2. Include urologists and cancer specialist on the panel.
  3. Point out that the NNT to prevent metastases and PC death is lower in younger, healthier men, in those trials that continue screening for many years,and in those that have longer follow-up.

The USPSTF is committed to understanding the needs and perspectives of the public it serves. Please share any experiences that you think could further inform the USPSTF on this draft Recommendation Statement.


  1. Because the cancer begins on the prostate’s outer edges, it produces no symptoms until it is far advanced and too late to cure.  An apparently ‘healthy’ man may have a steadily climbing PSA, silently trumpeting the danger alarm.
  2. African-American men were not included in studies used to make the guidelines and they are a group that benefit greatly from PSA screening.
  3. USPSTF recommendation could result in insurance not covering screening; this
    would be disproportionately detrimental to men in the less affluent African American community who are 50% more likely to be diagnosed with PC and 200% more likely to die of it.  This would unnecessarily increase healthcare disparities in the U.S.
  4. Side effects of prostate cancer treatment are greatly diminished with expert surgeons and ongoing improvements in treatment
  5. Gann et al reported studies reflecting what would happen if all PSA screening were to stop. In a study of the relationship between PSA values in blood samples drawn before the PSA era from the Physician’s Health Study, in men who
    subsequently were diagnosed with PC and died, the cause of death was PC in 75%.

Do you have other comments on this draft Recommendation Statement?


  1. PSA is the best screening test available for the early diagnosis prostate cancer, and until there is a replacement for PSA, it would be unconscionable to stop it.
  2. The risk of possible side effects should not be used as a fear tactic to discourage life-saving PSA screening and treatment.
  3. When I first started my prostate surgery practice more than 30 years ago, I would too often have to stand at the bedside of a patient and his family and tell them the operation went well, but the cancer had spread beyond the prostate and the prognosis was not good.  Even with the development of nerve-sparing surgery in the early 1980s, I had to say the same thing. Soon after the beginning of the PSA era in the early 1990s, there were far fewer patients with advanced disease. Because of early detection through PSA testing, the radical prostatectomy allowed for a cure in most patients, and the PC death rates plummeted.  Now, I am concerned, with the USPSTF’s recent misinterpretation of studies and ill advised recommendation, we will see a return to patients with advanced prostate cancer. It is a sad occasion for surgeons, patients, and patients’ families.  The outcry against the USPSTF recommendation resonates — nobody wants to go back there.

810

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Rudy Rips ‘prostate test’ Panel a New One

Posted on October 31, 2011 by jelandry

The Reason He’s Alive Today

Prostate-cancer survivor Rudy Giuliani yesterday blasted a government-backed panel’s advice to abandon routine prostate screening, joining a chorus of MDs decrying the recommendation as shoddy and dangerous.

“The [prostate-specific antigen] test saved my life,” Giuliani told The Post, noting he was in “perfect health” when he was tested at age 56. “I believe it’s the reason I’m alive. It’s really a mistake to move away from this. It’s very dangerous[ to abandon the test].’’

The US Preventive Services Task Force said the use of PSA testing for the No. 2 cancer killer causes more harm than good, kicking up a firestorm that rivaled its controversial 2009 recommendation that doctors scale back on routine mammograms.

Read more: New York Post

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Some Facts for My Newspaper Editor

Posted on October 31, 2011 by jelandry

A SURVIVOR PRESENTS SOME FACTS TO CONSIDER IN THE PROSTATE CANCER SCREENING DEBATE

What should not be lost in the PSA screening debate is the fact that prostate cancer is a “Terminator” and it’s estimated by the American Cancer Society(ACS) to kill 33,000 men by end of 2011 as 240,000 new cases are diagnosed. That fact makes it one of the top ten killers with only lung cancer being the greater “terminator”. Yet the US Preventive Service Task Force (USPSTF) report gives a very strong impression that this is an indolent, slow growing disease that does no harm.

Prostate cancer is a complex disease and yes, like gray hair, there is a form found in many aging men that is very slow growing and will not lead to medical problems or death. This is the class the USPSTF talks about a lot and uses to disparage the PSA test but there is an aggressive kind that is relentless and will kill if you don’t get rid it. (Dr.Charles E. Myers, Charlottesville Virginia.). Death involves the rapid spread of the malignancy to the lymph nodes, then the bones, the spine and eventually other organs and is difficult to cure if you don’t catch it early

If the draft recommendations of the USPTF are accepted and published as guidelines, the family doctors will not order the annual screening since insurers are already considering not paying for it. The report is being reviewed by Aetna and Kaiser Permanente who are saying they may not continue paying for the test.

Why would the Task Force disparage the PSA test and change the guidelines when there’s nothing to replace it? It’s not dangerous and quite like the blood work you have done on your kidney and liver functions, and in a retail clinic costs what a tank of gas or a dinner costs, $50. We have irrefutable proof that death rates from prostate cancer has fallen by 38% since 1992 with the wide spread use of the PSA screening test; and surely discontinuing the use of it will result in more deaths. Also more late stage victims who’s are too late to be cured will be showing up at their doctor’s office. It should be a concern to all, especially our African American brothers, who are more than twice is likely to get it than Whites or Hispanics. The headlines that were devoted to the USPTF Report does disparage the use of it and many men have already said, including my 67 brother-in-law, “Oh I read about it and the test is not accurate so I don’t need to be screened”.

Like our Susan G. Komen sisters in the breast cancer movement who kept the same USPSTF from eliminating annual mammograms, we want to be as effective in keeping this draft report from being accepted. Our brothers should not let this message be suppressed or lost. It’s should be heard by all Houstonians and our family doctors. Please let the task force know that the PSA test is critical and eliminating it may let 20 to 30,000 men die needlessly. You have until November 8th to take action and to be heard. Make your comments here at the USPSTF web site http://www.uspreventiveservicestaskforce.org/uspstf_form3/.

Sincerely,
Joe Landry, Ph.D., Founder ProtonPals, a non-profit national group of over 900 prostate cancer survivors.

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